Provider Demographics
NPI:1205981495
Name:YOO, MINJA (MD)
Entity type:Individual
Prefix:MRS
First Name:MINJA
Middle Name:
Last Name:YOO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 AMHERST DR
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10804-1815
Mailing Address - Country:US
Mailing Address - Phone:914-632-2187
Mailing Address - Fax:
Practice Address - Street 1:WEST 32ND ST.
Practice Address - Street 2:SUITE 1200 ANESTHESIA PROVIDERS 38
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001
Practice Address - Country:US
Practice Address - Phone:212-629-8181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY115208174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00211876Medicaid
NM566341Medicare ID - Type Unspecified